Mechanical Performance of Extensive Restorations Made with Short Fiber-Reinforced Composites without Coverage: A Systematic Review of In Vitro Studies.

In recent years, composite resin materials have been the most frequently used materials for direct restorations of posterior teeth. These materials have some clinically relevant limitations due to their lack of fracture toughness, especially when used in larger cavities with high volume factors or when utilized as direct or indirect overlays or crown restorations. Recently, short-fiber-reinforced composite materials have been used in bi-structure restorations as a dentine substituting material due to their superior mechanical properties; however, there is no scientific consensus as to whether they can be used as full restorations. The aim of our review was to examine the available literature and gather scientific evidence on this matter. Two independent authors performed a thorough literature search using PubMed and ScienceDirect up until December 2023. This study followed the PRISMA guidelines, and the risk of bias was assessed using the QUIN tool. The authors selected in vitro studies that used short-fiber-reinforced composite materials as complete restorations, with a conventional composite material as a comparison group. Out of 2079 potentially relevant articles, 16 met our inclusion criteria. All of the included studies reported that the usage of short-fiber-reinforced composites improved the restoration's load-bearing capacity. Fifteen of the included publications examined the fracture pattern, and thirteen of them reported a more favorable fracture outcome for the short-fiber-reinforced group. Only one article reported a more favorable fracture pattern for the control group; however, the difference between groups was not significant. Within the limitations of this review, the evidence suggests that short-fiber-reinforced composites can be used effectively as complete restorations to reinforce structurally compromised teeth.

The role of 3D technology in the practical education of congenital coarctation and its treatment-a feasibility pilot study.

BACKGROUND: Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education. METHODS: Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions. RESULTS: 21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference. CONCLUSIONS: Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students.

Novel Technique to Reconstruct Peri-Implant Keratinised Mucosa Width Using Xenogeneic Dermal Matrix. Clinical Case Series.

Reconstruction of sufficient buccal peri-implant keratinised mucosa width (PIKM-W) is reported to reduce the symptoms of peri-implantitis. In order to reduce the drawbacks of autogenous graft harvesting, we investigated a novel porcine dermal matrix (XDM, mucoderm®) using a modified surgical technique for augmentation of PIKM-W. Twenty-four patients were recruited with insufficient (<2 mm) PIKM-W. After split thickness flap preparation, the XDM was trimmed, rehydrated and tightly attached to the recipient periosteal bed using modified internal/external horizontal periosteal mattress sutures via secondary wound healing. Change of the PIKM-W and dimension of the graft remodelling were evaluated at 6 and 12 months postoperatively. The mean PIKM-W changed from 0.42 ± 0.47 to 3.17 ± 1.21 mm at 6 M and to 2.36 ± 1.34 mm at 12 M in the maxilla and from 0.29 ± 0.45 mm to 1.58 ± 1.44 mm at 6 M and to 1.08 ± 1.07 mm at 12 M in the mandible. Graft dimensions decreased by 67.7 ± 11.8% and 81.6 ± 16.6% at 6 M, and continued to 75.9 ± 13.9% and 87.4 ± 12.3% at 12 M, in the maxilla and mandible, respectively. Clinical parameters showed statistically significant intra- and intergroup differences between the baseline and 6 and 12 months (p < 0.05). The present technique using the XDM was safe and successfully reconstructed PIKM-W in both arches. The XDM alone seems to be a suitable alternative to autograft for PIKM-W augmentation in the maxilla.

Alveolar cleft reconstruction utilizing a particulate autogenous tooth graft and a novel split-thickness papilla curtain flap - A retrospective study.

During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g. intraoral bone, xenografts) have been tested. Autogenous tooth bone graft (ATB) is a novel material derived from extracted teeth. ATB has successfully been used in pre-prosthetic and periodontal surgery for hard-tissue reconstruction. Seven patients with unilateral cleft lip and palate were treated with ATB, using their own deciduous teeth for grafting. Defects were accessed utilizing a novel split-thickness papilla curtain flap. Cone-beam computed tomography scans were taken prior to and 3 months following cleft surgery to assess graft integration, graft stability, and the volume of the newly formed hard tissues. Hard-tissue gain, as measured at the 3-month follow-up, averaged 0.65 cm3 ± 0.26 cm3. Results showed acceptable graft integration and stability at the 3-month follow-up, with no adverse effects or excessive resorption of the graft. The use of ATB might be a feasible alternative for alveolar cleft grafting. However, long-term studies using a large sample size are required to derive further conclusions.

Possible Applications for a Biodegradable Magnesium Membrane in Alveolar Ridge Augmentation-Retrospective Case Report with Two Years of Follow-Up.

Background and Objectives: A rigid, resorbable magnesium membrane was recently developed, combining the advantages of resorbable and non-resorbable membranes. Our aim was to describe the application of this membrane for guided bone regeneration (GBR). Materials and Methods: This case report described the treatment and 3D evaluation of two cases utilizing a resorbable magnesium barrier membrane. In Case #1, GBR was performed with a bilayer tunnel flap. The magnesium barrier was placed fixed subperiosteally through remote vertical incisions. In Case #2, GBR was performed using a split-thickness flap design. Volumetric and linear hard tissue alterations were assessed by 3D cone-beam computed tomography subtraction analysis, as well as with conventional intraoral radiography. Results: Case #1 showed a volumetric hard tissue gain of 0.12 cm3, whereas Case #2 presented a 0.36 cm3 hard tissue gain. No marginal peri-implant hard tissue loss could be detected at the two-year follow-up. Conclusions: The application of conventional resorbable collagen membranes would be difficult in either of the cases presented. However, the rigid structure of the magnesium membrane allowed for the limitations of conventional resorbable membranes to be overcome.

[The role of 3D technology in the support of mechanical circulation therapy.] / A 3D technológia szerepe a muszívterápiában.

INTRODUCTION: Successful mechanical circulatory support is influenced by various factors, which are difficult or impossible to control. For ideal functioning of the left ventricular assist device inflow-cannula, its axis should be close to parallel with the septum, facing the mitral valve within the left ventricle. Numerous international publications discuss that deviation from optimal implantation can lead to inadequate functioning and serious complications. OBJECTIVE: Our objective was to developing a method, which, using 3D technology, anatomical and hydrodynamic data, makes optimal surgical implantation of the left ventricular assist device possible. METHOD: Data of 57 patients, receiving mechanical circulatory support at Semmelweis University, Heart and Vascular Center, were analyzed retrospectively. Results of operations performed with the patented novel navigation device (exoskeleton) were compared with results of operations performed conventionally, without navigation (control group). Following pairing based on estimated participation probability, postoperative data of 7-7 patients were compared. DICOM files from CT angiography images were used to create virtual geometries of individual hearts. Optimal inflow-cannula angle was determined through hydrodynamic simulation. Exoskeletons were printed using synthetic resin suitable for surgical purposes. Exoskeleton templates guided punch knife positioning and inflow-cannula implantation. RESULTS: Evaluation of postoperative CT angiography images showed that the angle between inflow-cannula and interventricular septum significantly differed in the exoskeleton and control groups (10.13° ± 2.69° vs. 22.87° ± 12.38°, p = 0.0208). Hydrodynamic tests found significantly lower turbulence in the exoskeleton group. Simulated turbulent kinetic energy was significantly lower in the exoskeleton group, which was 11.7 m2/s2 ± 9.39 m2/s2 vs. 49.59 m2/s2 ± 7.61 m2/s2 on average. CONCLUSION: The results suggest left ventricular assist device implantation with patented exoskeleton to be a standardizable, safe and effective method. Preliminary results suggest, that the method may facilitate individualized care, reduce surgical time and incidence of serious complications. Orv Hetil. 2023; 164(26): 1026-1033.

Efficacy and volume stability of a customized allogeneic bone block for the reconstruction of advanced alveolar ridge deficiencies at the anterior maxillary region: a retrospective radiographic evaluation.

OBJECTIVES: The aim of this retrospective case series was to evaluate the efficacy and volume stability of a customized allogeneic bone block (CABB) for the hard tissue reconstruction of severely atrophied anterior maxillary ridges. MATERIALS AND METHODS: Hard tissue alterations between baseline (T1), 2-month follow-up (T2), and 6-month follow-up (T3) cone-beam computed tomography scans were evaluated with semi-automatic segmentation. Following automatic spatial alignment of the datasets, 3D subtraction analysis was performed. The volume stability of the inserted allogeneic bone block was determined on the basis of the ratio of the T3 and T2 hard tissue volumes. RESULTS: The newly formed hard tissue volume at T2 averaged at of 0.75 cm3 ± 0.57 cm3, whereas at T3, an average of 0.52 cm3 ± 0.42 cm3 volumetric hard tissue gain could be detected. The T3/T2 ratio was found to be 67.83% ± 18.72% on average. The dice similarity coefficient between the T2 and T3 hard tissue models averaged at 0.73 ± 0.15. CONCLUSIONS: Cancellous CABBs are a reliable option for the reconstruction of severely atrophied alveolar ridges. The resorption rates of these grafts are similar to those found in the literature; however, with precise manufacturing and proper intraoperative flap management, the resorption rates may be reduced. CLINICAL RELEVANCE: With precise knowledge of the resorption patterns, the shape of blocks can be altered in the future to compensate for the volumetric loss.

Presentation of a novel surgical technique in periodontally accelerated osteogenic orthodontics. CBCT assessment of the buccal alveolar dimensional changes: a proof-of-concept report of four cases.

OBJECTIVES: The aim of this report was to present the effectiveness of a novel augmented corticotomy performed before orthodontic treatments in the prevention of buccal alveolar dehiscence and gingival recession. METHOD AND MATERIALS: Four periodontally healthy individuals presenting crowding and thin bone morphotype in the mandibular anterior area were treated with a double-layer tunnel flap, piezotomy, and hard and soft-tissue augmentation. Patients were divided into two groups according to the utilized graft material. The exclusive use of demineralized bovine bone minerals (group 2) was compared to the use of autologous concentrated growth factor-enriched bone graft matrix, "sticky bone" (group 1). CBCT measurements were performed before and 6 months after surgery. Orthodontic treatment was initialized 1 week after surgery. RESULTS: Postoperative wound healing was uneventful, and tooth alignments were successful in all cases. Postoperative buccal hard tissue dimensions were favorable in both groups, with no occurring bone dehiscence or gingival recession. The seemingly better results of group 2, in terms of quantitative hard tissue changes, did not have any clinical significance according to the objective to be achieved. In contrast, qualitative radiographic analysis showed a more homogenous tissue formation around teeth in group 1. CONCLUSION: It can be concluded that the presented preorthodontic treatment approach seems to be successful in preventing alveolar dehiscence and gingival recession around buccally inclined mandibular anterior teeth.

Three-dimensional volumetric assessment of hard tissue alterations following horizontal guided bone regeneration using a split-thickness flap design: A case series.

OBJECTIVES: To analyze morphological, volumetric, and linear hard tissue changes following horizontal ridge augmentation using a three-dimensional radiographic method. METHODS: As part of a larger ongoing prospective study, 10 lower lateral surgical sites were selected for evaluation. Horizontal ridge deficiencies were treated with guided bone regeneration (GBR) using a split-thickness flap design and a resorbable collagen barrier membrane. Following the segmentation of baseline and 6-month follow-up cone-beam computed tomography scans, volumetric, linear, and morphological hard tissue changes and the efficacy of the augmentation were assessed (expressed by the volume-to-surface ratio). RESULTS: Volumetric hard tissue gain averaged 605.32 ± 380.68 mm3. An average of 238.48 ± 127.82 mm3 hard tissue loss was also detected at the lingual aspect of the surgical area. Horizontal hard tissue gain averaged 3.00 ± 1.45 mm. Midcrestal vertical hard tissue loss averaged 1.18 ± 0.81 mm. The volume-to-surface ratio averaged 1.19 ± 0.52 mm3/mm2. The three-dimensional analysis showed slight lingual or crestal hard tissue resorption in all cases. In certain instances, the greatest extent of hard tissue gain was observed 2-3 mm apical to the initial level of the marginal crest. CONCLUSIONS: With the applied method, previously unreported aspects of hard tissue changes following horizontal GBR could be examined. Midcrestal bone resorption was demonstrated, most likely caused by increased osteoclast activity following the elevation of the periosteum. The volume-to-surface ratio expressed the efficacy of the procedure independent of the size of the surgical area.

Reconstruction of vertical alveolar ridge deficiencies utilizing a high-density polytetrafluoroethylene membrane /clinical impact of flap dehiscence on treatment outcomes: case series/.

OBJECTIVES: The aim of this study was to evaluate the effects of membrane exposure during vertical ridge augmentation (VRA) utilizing guided bone regeneration with a dense polytetrafluoroethylene (d-PTFE) membrane and a tent-pole space maintaining approach by registering radiographic volumetric, linear and morphological changes. METHODS: In 8 cases alveolar ridge defects were accessed utilizing a split-thickness flap design. Following flap elevation VRA was performed with tent-pole space maintaining approach utilizing the combination of a non-reinforced d-PTFE membrane and a composite graft (1:1 ratio of autogenous bone chips and bovine derived xenografts). Three-dimensional radiographic evaluation of hard tissue changes was carried out with the sequence of cone-beam computed tomography (CBCT) image segmentation, spatial registration and 3D subtraction analysis. RESULTS: Class I or class II membrane exposure was observed in four cases. Average hard tissue gain was found to be 0.70 cm3 ± 0.31 cm3 and 0.82 cm3 ± 0.40 cm3 with and without membrane exposure resulting in a 17% difference. Vertical hard tissue gain averaged 4.06 mm ± 0.56 mm and 3.55 mm ± 0.43 mm in case of submerged and open healing, respectively. Difference in this regard was 14% between the two groups. Horizontal ridge width at 9-month follow-up was 5.89 mm ± 0.51 mm and 5.61 mm ± 1.21 mm with and without a membrane exposure respectively, resulting in a 5% difference. CONCLUSIONS: With the help of the currently reported 3D radiographic evaluation method, it can be concluded that exposure of the new-generation d-PTFE membrane had less negative impact on clinical results compared to literature data reporting on expanded polytetrafluoroethylene membranes.

Utilizing a novel radiographic image segmentation method for the assessment of periodontal healing following regenerative surgical treatment.

OBJECTIVE: The aim of the current article was to present a radiographic method to determine the surface area of newly formed periodontal attachment, as well as to analyze volumetric and morphologic changes after regenerative periodontal treatment. METHOD AND MATERIALS: In this retrospective study, 11 singular intrabony periodontal defects were selected for minimally invasive surgical treatment and 3D evaluation. 3D virtual models were acquired by the segmentation of pre- and postoperative CBCT scans. This study determined the surface area of baseline periodontal attachment (RSA-A) and defect-involved root surface (RSA-D) on the preoperative 3D models, and the surface area of new periodontal attachment (RSA-NA) on the postoperative models. Finally, cumulative change of periodontal attachment (∆RSA-A) was calculated and Boolean subtraction was applied on pre- and postoperative 3D models to demonstrate postoperative 3D hard tissue alterations. RESULTS: The average RSA-A was 84.39 ± 33.27 mm2, while the average RSA-D was 24.26 ± 11.94 mm2. The average surface area of RSA-NA after regenerative periodontal surgery was 17.68 ± 10.56 mm2. Additionally, ∆RSA-A was determined to assess the overall effects of ridge alterations on periodontal attachment, averaging 15.53 ± 12.47 mm2, which was found to be statistically significant (P = .00149). Lastly, the volumetric hard tissue gain was found to be 33.56 ± 19.35 mm3, whereas hard tissue resorption of 26.31 ± 38.39 mm3 occurred. CONCLUSION: The proposed 3D radiographic method provides a detailed understanding of new periodontal attachment formation and hard tissue alterations following regenerative surgical treatment of intrabony periodontal defects.

The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial.

OBJECTIVES: Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). MATERIALS AND METHODS: Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. RESULTS: After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4-5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score. CONCLUSIONS: Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. CLINICAL RELEVANCE: In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

CBCT subtraction analysis of 3D changes following alveolar ridge preservation: a case series of 10 patients with 6-months follow-up.

AIM: The purpose of this article is to present a novel method for the CBCT subtraction analysis of 3D changes following alveolar ridge preservation (ARP) with the application of a semi-automatic segmentation workflow and spatial registration. The study hypothesis was that by utilizing our novel approach, better 3D visualization and improved volumetric and linear evaluations of alveolar reconstructive procedures could be achieved following ARP compared with existing methodologies. MATERIALS AND METHODS: Ten surgical sites of 10 partially edentulous patients were treated with a tunneled guided bone regeneration approach for ARP. Spatial registration and a semi-automatic segmentation method were utilized to create 3D digital models of pre- and postoperative CBCT datasets for subtraction analysis. The primary outcome variable of the study was the volumetric difference between pre- and postoperative CBCT scans. Secondary outcome variables were horizontal and vertical linear measurements at the mesial, distal, and middle aspects of the alveolus. RESULTS: Change of hard tissue volume averaged at 0.34 ± 0.99 cm3. The mean change of vertical hard tissue dimension was 5.97 ± 3.18 mm at the mesial, 6.40 ± 3.03 mm at the distal, and 7.01 ± 3.02 mm at the middle aspect of the extraction sites. Horizontal linear changes averaged at 6.19 ± 0.68 mm at the mesial, 6.32 ± 1.52 mm at the distal, and 6.90 ± 1.48 mm at the middle aspects of the extraction sites. CONCLUSION: The digital reconstruction of CBCT datasets with the presented approach may provide a better understanding of the healing mechanisms following ARP. Not only the direct effect on extraction socket healing, but also the indirect positive effect on adjacent teeth can be visualized.

Digital Hybrid Model Preparation for Virtual Planning of Reconstructive Dentoalveolar Surgical Procedures.

Virtual, hybrid three-dimensional (3D) model acquisition is presented in this article, utilizing the sequence of radiographic image segmentation, spatial registration, and free-form surface modeling. Firstly cone-beam computed tomography datasets were reconstructed with a semi-automatic segmentation method. Alveolar bone and teeth are separated into different segments, allowing 3D morphology, and localization of periodontal intrabony defects to be assessed. The severity, extent, and morphology of acute and chronic alveolar ridge defects are validated concerning adjacent teeth. On virtual complex tissue models, positions of dental implants can be planned in 3D. Utilizing spatial registration of IOS and CBCT data and subsequent free-form surface modeling, realistic 3D hybrid models can be acquired, visualizing alveolar bone, teeth, and soft tissues. With the superimposition of IOS and CBCT soft tissue, thickness above the edentulous ridge can be assessed about the underlying bone dimensions; therefore, flap design and surgical flap management can be determined, and occasional complications may be avoided.

Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption.

OBJECTIVE: The purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect. MATERIALS AND METHODS: CBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation. RESULTS: The osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%). CONCLUSIONS: The avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.

Vascular survey of the maxillary vestibule and gingiva-clinical impact on incision and flap design in periodontal and implant surgeries.

OBJECTIVES: Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs. MATERIALS AND METHODS: Thirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT). RESULTS: Transverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected. CONCLUSIONS: The macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries. CLINICAL RELEVANCE: This study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.

Digital three-dimensional visualization of intrabony periodontal defects for regenerative surgical treatment planning.

BACKGROUND: In the regenerative treatment of intrabony periodontal defects, surgical strategies are primarily determined by defect morphologies. In certain cases, however, direct clinical measurements and intraoral radiographs do not provide sufficient information on defect morphologies. Therefore, the application of cone-beam computed tomography (CBCT) has been proposed in specific cases. 3D virtual models reconstructed with automatic thresholding algorithms have already been used for diagnostic purposes. The aim of this study was to utilize 3D virtual models, generated with a semi-automatic segmentation method, for the treatment planning of minimally invasive periodontal surgeries and to evaluate the accuracy of the virtual models, by comparing digital measurements to direct intrasurgical measurements. METHODS: Four patients with a total of six intrabony periodontal defects were enrolled in the present study. Two months following initial periodontal treatment, a CBCT scan was taken. The novel semi-automatic segmentation method was performed in an open-source medical image processing software (3D Slicer) to acquire virtual 3D models of alveolar and dental structures. Intrasurgical and digital measurements were taken, and results were compared to validate the accuracy of the digital models. Defect characteristics were determined prior to surgery with conventional diagnostic methods and 3D virtual models. Diagnostic assessments were compared to the actual defect morphology during surgery. RESULTS: Differences between intrasurgical and digital measurements in depth and width of intrabony components of periodontal defects averaged 0.31 ± 0.21 mm and 0.41 ± 0.44 mm, respectively. In five out of six cases, defect characteristics could not be assessed precisely with direct clinical measurements and intraoral radiographs. 3D models generated with the presented semi-automatic segmentation method depicted the defect characteristics correctly in all six cases. CONCLUSION: It can be concluded that 3D virtual models acquired with the described semi-automatic segmentation method provide accurate information on intrabony periodontal defect morphologies, thus influencing the treatment strategy. Within the limitations of this study, models were found to be accurate; however, further investigation with a standardized validation process on a large number of participants has to be conducted.

[The significance of biotype in the predictability of dental-periodontal treatment]. / Biotípus jelentosége a fogászati-parodontélis kezelések kiszámíthatóságában. Irodalmi összefoglaló és keresztmetszeti vizsgálat.

BACKGROUND: The dimension of attached gingiva is a very important landmark in the periodontal health, and determine the function of the mucogingival unit, the progression of marginal inflammation and also affects aesthetic dentistry, orthodontics and implantology. The determination of gingival/periodontal biotype is important in dental/periodontal practice. Hence, the aim of this cross sectional clinical study was to assess the width and thickness of attached gingiva in young, periodontally healthy individuals and to provide anthropometric data in Hungary. MATERIALS AND METHODS: 68 periodontally healthy (between the age of 14-28) individuals participated in the study. The thickness of the gingiva was determined using transgingival transparency of periodontal probe at each tooth in the maxillary and mandibular dental arch. Based on this non-invasive technique three biotype categories were determined i.e. thin > 1 mm, medium 1-2 mm and thick < 2 mm. The width of the gingiva was assessed by William's graduated probe measuring the distance between the gingival margin and mucogingival line the midline of each tooth. The data were statistically analyzed and compared according to gender, dental arch and group of teeth. RESULTS: The gingiva was found to be thinner in females than males. The thin biotype was significantly more common among females while in males the thick biotype was the dominant. The individual variations were common within dental arch and many times the biotype switched from tooth to tooth. The average width of the attached gingiva was wider in the maxilla than in the mandible and there was no statistically significant correlation between the biotype and the width of attached gingiva. Manifest gingival recession occurred just around teeth with thin biotype. CONCLUSION: In the present study, we concluded that gingival thickness and width varies with gender and dental arch location and the biotype had no effect on the width of attached gingiva.